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Moderate-Intensity Statin Plus Ezetimibe: Time to Rethink it as an Optimal Initial Lipid-Lowering Strategy
Sha Li1, Hui-Hui Liu1, Jian-Jun Li2
1Cardiometabolic Center, State Key Laboratory of Cardiovascular Disease, FuWai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing, 100037, China.
Insights
Achieving low-density lipoprotein cholesterol (LDL-C) targets is vital for cardiovascular disease (CVD) prevention. Moderate-intensity statins plus ezetimibe offer an effective, safer alternative to high-intensity statins for better real-world LDL-C control.
Area of Science:
- Cardiology
- Pharmacology
- Public Health
Background:
- Low-density lipoprotein cholesterol (LDL-C) target achievement is critical for preventing cardiovascular disease (CVD) in high-risk dyslipidaemia patients.
- Current guidelines advocate high-intensity statins, but real-world adherence and efficacy are suboptimal due to challenges like hesitancy, side effects, and variable responses.
- High-intensity statin underuse and suboptimal LDL-C goal attainment are significant issues in clinical practice.
Purpose of the Study:
- To review clinical evidence, treatment guidelines, and challenges related to high-intensity statin therapy for LDL-C management.
- To summarize evidence supporting moderate-intensity statin plus ezetimibe combination therapy as a primary treatment strategy.
- To evaluate the potential of upfront moderate-intensity statin plus ezetimibe for improving LDL-C control and CVD prevention.
Main Methods:
- Review of existing clinical evidence on statin therapy and combination treatments.
- Analysis of current lipid management guidelines, focusing on the 2023 Chinese Guideline for Lipid Management.
- Comparative assessment of high-intensity statins versus moderate-intensity statin plus ezetimibe regarding efficacy, safety, and adherence.
Main Results:
- High-intensity statins are underused, leading to suboptimal LDL-C goal achievement in real-world settings.
- Moderate-intensity statin plus ezetimibe demonstrates considerable efficacy and effectiveness.
- This combination therapy shows better safety and adherence compared to escalating statin therapy alone.
Conclusions:
- The upfront use of moderate-intensity statin plus ezetimibe is recommended by the 2023 Chinese Guideline for Lipid Management.
- This combination strategy offers a viable alternative to address challenges associated with high-intensity statins.
- Implementing moderate-intensity statin plus ezetimibe as a primary treatment may enhance LDL-C control and improve CVD prevention outcomes.
Abstract:
Achievement of low-density lipoprotein cholesterol (LDL-C) targets is crucial for the prevention of cardiovascular disease (CVD) in individuals with dyslipidaemia who are at high risk. Current guidelines recommend high-intensity statins at the highest tolerated dose as initial treatment to achieve LDL-C goals. However, the real-world situation is dismal: high-intensity statins are underused and achievement of LDL-C goals is suboptimal. Various challenges exist in the implementation of the recommended initial treatment strategy, including hesitancy to use high-intensity statins, non-adherence, and side effects, and the response to high-intensity statins varies across individuals. Emerging studies have shown another line of lipid-lowering, moderate-intensity statins in combination with ezetimibe, presenting considerable efficacy/effectiveness, along with better safety and adherence compared to statin intensification alone. Here we review the clinical evidence, treatment guidelines and challenges associated with high-intensity statins, and summarise the evidence on the combination therapy, moderate-intensity statin plus ezetimibe, which is the core strategy recommended by the 2023 Chinese Guideline for Lipid Management, as a possible primary treatment to achieve the LDL-C targets across several populations. The upfront use of a moderate-intensity statin plus ezetimibe may improve LDL-C control and lead to the prevention of CVD in real-world settings.
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